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The earlier the remission from inflammatory polyarthritis, the longer the overall life expectancy

 MD-FM Thursday June 13, 2013 

 

Sarah:

MD-FM, Medical News from around the world with Peter Goodwin.

 

P1

PETER:

Hello, and with me is Sarah Maxwell. To begin with, patients with inflammatory poly-arthritis who achieved an early and sustained disease remission, had a reduced risk of death in a study published in the Annals of Rheumatoid Diseases

 

SARAH:

Yes, it showed that for patients with rheumatoid arthritis and other chronic inflammatory arthritis: achieving remission within the first three years of initial diagnosis was associated with a fall of about 30% in the risk of all-cause mortality. And, the earlier the remission occurred, the longer it lasted, the greater were the reductions in mortality:

 

Scirè 1: Patients with an achievement of remission at the first year and with a persistent remission within the first three years had more than 40% of reduction of mortality risk. So the achievement of remission at the first year was clearly better than after 3 years

 

SARAH:

Lead study author Dr. Carlo Scirè, from Italy, who said this early benefit is because chronic inflammation is associated with increased cardiovascular risks, and his data should encourage rheumatologists to adhere to early intensive treatment of inflammatory poly-arthritis. In this study, remission was defined according to the most stringent cut off for joint inflammation: the absence of clinically detectable joint inflammation on a 51-joint count

 

Scirè 2: We studied the effect of remission independently from medication, from disease severity characteristics, and we showed that drug induced remission was associated with an even better survival. So it’s not only that patients who go well continue to go well 

 

SARAH:

Carlo Scirè, from Pavia in Italy who was working with a British team based in Manchester.



P2

PETER:

For patients with RA, anti-tumour necrosis factor therapy might protect against small bowel injuries, caused by non-steroidal anti-inflammatory drugs, NSAIDs. That’s according to a study, published in Gut, that showed preventive use of TNF-alpha reduced severe damage in the small intestines of patients with RA who’d received NSAID for more than three months. This protective effect was maintained after adjustments for baseline characteristics.



VIRGULE MUSICALE



P3

PETER:

Now: from the annual Albatros congress on addictology, that took place last week in Paris, where experts agreed that: for alcoholics, reducing alcohol consumption is a reasonable alternative to complete abstinence because it helps reduce the damage caused by alcohol

 

SARAH:

Yes, Professor David Nutt, former UK Government adviser on drugs, chaired a session on new alcohol treatments at the meeting, and he told MDFM that; any amount of alcohol reduction is beneficial:

 

Nutt-1: The problem we have at present is basically we say to people: the only way we can help you is if you stop drinking. And most people say "why should I? I can see my friends drink normally, why can’t I drink normally?" And you say: "but you can’t drink normally!" Now we have a treatment to help people drink normally. So I think this is a really important advance, and it’s an advance obviously in terms of brains science and brain chemistry and brain treatment... But there’s got to be a parallel conceptual advance in people understanding the need, the value, of getting down drinking rather than just stopping drinking. Any reduction in alcohol intake, in anyone, is going to have health benefits and therefore a cost benefit 

 

SARAH:

That was David Nutt, from the UK, who explained that: alcohol is the drug causing the greatest harm to European societies today. Less than 10% of alcoholics actually seek treatment, so adding a new approach to tackle addiction is highly desirable and could bring new patients to the doctor:

 

Nutt-2: Alcohol is now the leading cause of death in men between 16 and 54 in the United Kingdom. The governments know it but they won’t do anything about it because the drinks industry is so powerful that they won’t stand up to the drinks industry 

 

SARAH:

Professor Nutt also added that stricter policies should be put in place, such as: increasing the price of alcohol, limiting it’s availability, and starting programs aimed at adolescents with a focus on educating them about alcohol misuse, to help prevent it early on:

 

Nutt-2 You need to try to stop young people from being intoxicated at the age of 10 or 12, which is the usual age that people start getting drunk now in Britain. I don’t know about France but I suspect France is going along the same way 

 

SARAH:  

David Nutt, from Imperial College, London.



VIRGULE MUSICALE

 

P4

PETER:

The looming threat from multidrug resistant gonorrhoea seems to have been delayed by changes made in antimicrobial prescribing patterns across the UK in 2011. That's according to a study, reported in The Lancet Infectious Diseases, that shows this change is associated with a decrease in drug-resistance

 

SARAH:

Yes, from 2007 to 2010, resistance to cefixime, the oral cephalosporin used first-line for gonorrhoea, had been growing rapidly. Although by 2011 resistance had not yet reached the 5% level often used to trigger policy changes: cefixime was nevertheless replaced by a high-dose, injectable form of another cephalosporin: ceftriaxone. Lead study author Professor Catherine Ison gave MDFM the thinking behind the new proactive approach:

 

Ison: Normally we would choose a new drug specifically for gonorrhoea to which there was no known resistance mechanism. But now we don’t have those drugs to use. And that’s why in 2011 the British Association for Sexual Health changed their guidelines pre-emptively before we reach that level. If we had waited until that time, the resistant bacteria would have been well established in the population, and possibly the highly active populations, and would have spread much more quickly. By using proactive approaches, we’re buying ourselves a bit of time until we get new drugs or we get clinical trials on old drugs used in combination 

 

SARAH:

That was Catherine Ison, from the UK Health Protection Agency, who added physicians should follow their national guidelines, since most countries have now endorsed similar proactive approaches.



VIRGULE MUSICALE



P5

PETER:

For older patients with depression, having specialized management of their illness within the primary care setting, can help them not only live better lives but also longer lives

 

SARAH:

Yes, that’s according to a study, published in the British Medical Journal, that showed: patients with major depression were nearly 25% more likely to be alive after eight years if they were in practices with specialized care for depression, compared to those managed with usual care:

 

Reynolds-1: The mainstay of treatment was the use of antidepressant pharmacotherapy but in approximately a third of patients, interpersonal psychotherapy (or IPT) was also provided. Patients in the study received up to two years of treatment, not only to help them get them well but to help keep them well 

 

SARAH:

That was Dr. Charles Reynolds, from Pittsburg, Pennsylvania, who said older people are often more reluctant to seek care from mental health specialists:

 

Reynolds-2: We think that stigma still represents a major barrier to appropriate treatment. Many older adults would prefer treatment either in their primary care setting, perhaps with a general practitioner or a family physician or, depending on their persuasions, they might seek help from a counselor such as a minister or a priest 

 

SARAH:

Charles Reynolds from the University of Pittsburgh School of Medicine, who also explained that reductions in mortality were mostly attributable to less cancer: which could be due to behavioural as well as biological reasons.



BREVE 1 Sur fond musical  

 

PETER:

The first gene linked to lumbar disc degeneration has been discovered, this is from data reported in the Annals of Rheumatic Diseases. And the researchers say: the PARK2 gene seems to be switched off in people with LDD. They hypothesize that environmental factors, such as lifestyle and diet, might trigger epigenetic modifications that could lead to this mutation.

 

And...

 

BREVE 2

 

PETER:

For infants with moderate-to-severe acute bronchiolitis, inhaled racemic adrenaline was not more effective than inhaled saline, in an eight-centre, randomized, double-blind trial published in the New England Journal of Medicine. Inhalation on demand, however, appeared better than inhalation on a fixed schedule at reducing length of hospital stay and the use of: ventilatory support, supplemental oxygen therapy, and naso-gastric-tube feeding.



That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until them from me Peter Goodwin, goodbye!

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